Earache, most disturbing human experience

Earache (or ear-pain ) is one of the most disturbing of human experiences .Mostly it is due to problem in the ear itself and diagnosis is simple after accurate history and thorough examination of ear, nose and throat.

 Sometimes earache may be referred from pathology of remote areas (known as referred earache). Nerves supplying sensation to ear also supplies to other areas and because of some unexplainable reasons brain gets confused and perceives as earache when in fact problem may be in another part of the body.

 To find out the cause then is a challenge to E.N.T. specialist.

In children sometimes it may be just a reason to escape from school. 

Causes of earache- 

Most common causes of earache are otitis externa, acute otitis media, Eustachian tube blockage and impacted wax

 

I. Causes in the ear-

Pinna- Trauma, Infection, Swelling, Frost-bite, Sunburn. 

Ear-canal- Otitis externa, Impacted wax, Furuncle (boil), Herpes Zoster, Tumor. 

Middle ear- Acute otitis media, Eustachian tube blockage, Glue ear, Aero-otitis media. 

II. Causes outside ear (Referred earache)– 

 1. Via 5th nerve (Trigeminal nerve)-

* Lesion from teeth and jaw- carious tooth, impacted wisdom tooth,

*Temporo-Mandibular joint disorder, 

* Oral cavity and tongue-ulcers,

* Nose and sinuses,

* Nasopharynx- ulcer/infection/after adenoids surgery,

 * Lesions in the salivary glands-mumps/ parotitis.

2. Via IX nerve  (Glossopharyngeal) 

*Lesions of base of tongue- ulcer, tumor,

*Lesions of oropharynx-  Pharyngitis/tonsillitis, Abscess of spaces around tonsil area, Ulcer, After tonsillectomy surgery

*Elongated styloid process stretching IX nerve. 

3. Via X nerve (Vagus nerve)- 

*Lesions in the laryngopharynx -t.b/malignancy,

*Lesions in the larynx-laryngitis,

*Lesions in the oesophagus-F.B./tumor 

4. Via Cervical 2nd and 3rd nerve

*Cervical disc lesions, *Cervical spine arthritis

 

 Otitis externa- it is infection of skin of outer ear and ear canal. Usually it is caused by moisture trapped inside the canal or injury to skin of ear canal during attempts of cleaning the ear.

Touching the ear or pulling the ear worsens the pain and there may be swelling of the ear with blocked ear feeling.

Treatment -Mostly combination antibiotic and steroid ear drops for 7-10 days is required. If swelling is severe a wick soaked with ear drops or ointment is placed in the canal.

Oral antibiotics and analgesics may be prescribed.

Small cotton ball soaked in Vaseline can be used during bathing to avoid water entry into the ear.

If abscess (accumulation of pus) develops, incision and drainage may be required. 

 Impacted wax and foreign bodies- Ear wax is not a disease rather it makes protective layer in the ear canal. Obsessive attempts to remove the wax at home may be dangerous. Impacted wax causing obstruction and foreign bodies are removed by instruments or syringing. If wax is very hard then wax-softening ear drops may be prescribed for 5-7 days before attempting cleaning of ear. 

Eustachian-tube block and glue ear-Eustachian tube communicates the middle ear with nasopharynx. It helps in ventilation of middle ear and drainage of fluid from middle ear. Tube blockage may be because of cold, allergy, sinusitis, adenoids or sore throat, and is more common in children due to shorter tube. Fluid accumulates behind the ear drum (glue ear) and increasing pressure may cause pain in the ear.

Treatment is by antibiotic, oral decongestants, nasal drops and if fluid persists for more than 3 months then a small tube (Grommet) may be placed into ear drum.  

Otitis media-Otitis media is infection of middle ear often spread from cold, flu, sore throat or allergy.

Treatment -antibiotics, pain killer, decongestants oral/nasal and antibiotic ear drops.

 

 Earache may be because of myriad of reasons. A cold pack or hot pack may be applied to the ear to reduce pain along with some safe over the counter pain-relievers. If pain is severe, continuous or associated with hearing problem, dizziness, headache, fever or is simply unexplainable you should visit some medical professional. Please don’t try to experiment with your ear.

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